The Curbsiders Addiction Medicine Podcast

S2 Ep13: #24 Treating OUD in the Fentanyl Era: ASAM Treatment Week with Dr. Melissa Weimer

18 snips
Oct 17, 2023
Guest
Melissa Weimer
Dr. Melissa Weimer from Yale University discusses treating opioid use disorder in the fentanyl era. Topics include methadone and buprenorphine initiation changes, pitfalls, precipitated withdrawal, dosing strategies, and individualized care. Learn how to provide person-centered care and address challenges in addiction medicine.
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ADVICE

Methadone Starting Dose for High Tolerance

  • Start patients on 30-40mg of methadone on day one if they have high tolerance to fentanyl.
  • Supplement with short-acting opioids for pain and withdrawal.
ADVICE

Methadone Dosing Pitfalls

  • Avoid prescribing very low or very high doses of methadone initially.
  • Consult addiction medicine specialists if unsure about methadone dosing.
ADVICE

Methadone Titration Schedule

  • Increase methadone by 10mg daily up to 60mg, then wait three to five days.
  • Remember to always give more short-acting opioids if needed but never less.
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